Football and dementia: looking at other factors
Authors: Chika Edward Uzoigwe, Rana Muhammad Anss Bin Qadir
Journal: The Lancet Public Health (2023)

Peter Ueda and colleagues1Ueda P Pasternak B Lim CE et al.Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study.Lancet Public Health. 2023; 8: e256-e265Summary Full Text Full Text PDF PubMed Google Scholar make an important contribution to the literature regarding a potentially long-term consequence of football, possibly related to heading the ball. Physical activity is generally considered healthy, so finding an increased risk of neurodegenerative disease from heading the ball is surprising; but has been replicated by other studies. The authors observed increased risk of neurodegenerative disease, specifically dementia but not other neurodegenerative conditions, in outfield football players. However, one potential confounder is overlooked. There is very strong evidence that educational attainment is protective against dementia,2Lövdén M Fratiglioni L Glymour MM Lindenberger U Tucker-Drob EM Education and cognitive functioning across the life span.Psychol Sci Public Interest. 2020; 21: 6-41Crossref PubMed Scopus (216) Google Scholar, 3Hyun J Hall CB Katz MJ et al.Education, occupational complexity, and incident dementia: a COSMIC collaborative cohort study.J Alzheimers Dis. 2022; 85: 179-196Crossref PubMed Google Scholar, 4Hoang MT Kåreholt I von Koch L et al.Influence of education and income on receipt of dementia care in Sweden.J Am Med Dir Assoc. 2021; 22: 2100-2107Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar and this has been observed in Sweden.4Hoang MT Kåreholt I von Koch L et al.Influence of education and income on receipt of dementia care in Sweden.J Am Med Dir Assoc. 2021; 22: 2100-2107Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Engagement with football to the level of the top Swedish division potentially reduces the likelihood of progression to higher educational institutions, and thus could reduce exposure to this protective factor. Could failure to match for educational attainment in controls explain the findings? Moreover, Ueda and colleagues observed that goalkeepers had a lower risk of neurodegenerative disease than outfield players. This observation would suggest heading the ball increases the risk of dementia, given that goalkeepers are permitted to handle the ball and are therefore less likely to contact the ball with their head. However, goalkeepers can have physical attributes that are different to other players. Increasing height has been strongly correlated with a lower risk of dementia,5Jørgensen TSH Okholm GT Christensen K Sørensen TI Osler M Body height in young adult men and risk of dementia later in adult life.eLife. 2020; 9e51168Crossref Scopus (7) Google Scholar and goalkeepers tend to be taller than outfield players.6Poli R Ravenel L Besson R CIES Football Observatory Monthly Report 22—goalkeepers: what kind of specifics?.https://www.football-observatory.com/IMG/pdf/mr22en.pdfDate: 2017Date accessed: April 5, 2023Google Scholar Therefore, could height be a confounding factor? In summary, educational attainment and height are two important covariates that are unmatched in the control cohort and could account for Ueda and colleagues’ findings. We declare no competing interests. Football and dementia: looking at other factors – Authors' replyWe thank Uzoigwe and Bin Qadir for their reflections on our Article1 regarding potential factors such as education and height. As described in our Article,1 we have previously presented data on educational outcomes among male elite football players and male general population controls.2 Here we present more data on variables that might be associated with risk of neurodegenerative disease (including education and height) among men from the Swedish general population (previously published2), outfield players, and goalkeepers. Full-Text PDF Open Access